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pharmacology > pharmacotherapy of arterial hypertension > Flashcards

pharmacotherapy of arterial hypertension Flashcards

1
Q

in arterial hypertension patient should also be advised on what other than medication ?

A

physical activity and dietary changes

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2
Q

what is the classification for cardiovascular risk for patients with arterial hypertension with no concomitant condition or risk factors (smoking etc)

A

high normal bp (130-139) / (85-89)
= no risk

Grade 1
(140-159 )/ (90-99)
= low risk

grade 2
(160-179) / (100-109)
= moderate risk (initiate therapy from here)

grade 3
over 180/110
=high risk

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3
Q

what is the classification for cardiovascular risk for patients with arterial hypertension with 1-2 additional risk factors

A

high normal bp (130-139) / (85-89)
= low risk

Grade 1
(140-159 )/ (90-99)
= moderate risk

grade 2
(160-179) / (100-109)
= moderate risk / high risk

grade 3
over 180/110
=high risk

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4
Q

what is the classification for cardiovascular risk for patients with arterial hypertension with more than 3 additional risk factors

A

high normal bp (130-139) / (85-89)
= low / moderate risk

Grade 1
(140-159 )/ (90-99)
= moderate /high risk

grade 2
(160-179) / (100-109)
= high risk

grade 3
over 180/110
=high risk

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5
Q

what is the classification for cardiovascular risk for patients with arterial hypertension with organ damage / chronic kidney disease stage 3 / diabetes mellitus

A

high normal bp (130-139) / (85-89)
= moderate risk / high risk

Grade 1
(140-159 )/ (90-99)
= high risk

grade 2
(160-179) / (100-109)
= high risk

grade 3
over 180/110
=high risk

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6
Q

what is the classification for cardiovascular risk for patients with arterial hypertension with symptomatic cardiovascular disease
chronic kidney disease stage 4 or more diabetes mellitus with organ damage or risk factors

A

high normal bp (130-139) / (85-89)
= very high risk

Grade 1
(140-159 )/ (90-99)
= very high risk

grade 2
(160-179) / (100-109)
= very high risk

grade 3
over 180/110
=very high risk

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7
Q

what does organ damage mean ?

A

asymptomatic such as RV OR LV hypertrophy

microalbuminuria

vascular damage

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8
Q

what are the risk factors when we say additional risk factors ?

A 
age 
male sex 
smoking 
dyslipidemia 
glucose intolerance 
obesity 
family history of premature Chronic vascular disease
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9
Q

what re the main groups of anti hypertensive drugs ?

A

diuretics

blockers of RAAS:

1) ACE inhibitors
2) angiotensin receptor blocker ARB
3) renin inhibitors
4) aldosterone antagonists

calcium channel blocker 
1) dihydropyridines
nifedipine
amlodipine 
feloDIPINE
DIPINE'S
2) non dehydropyridines 
verapamil 
diltiazem

beta adrenergic blocker BAB

1) non selective
2) cardio b1 selective
3) vasodilation

alpha adrenergic blocker

central sympatholytics

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10
Q

diuretics are further classified into ?

A

thiazides

and loop diuretics

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11
Q

what are the thiazide drugs ?

A

hydrochlorothiazide
chlorothadilone
indapamide

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12
Q

what are the loop diuretics ?

A

furosemide

torasemide

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13
Q

what is the mechanism of action in diuretics ?

A

reduce the peripheral vascular resistance by vasodilation in LOW DOSES

reduce the intravascular volume in HIGH DOSES through excretion

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14
Q

what is the antihypertensive effectiveness for diurectics ?

A

slight to moderate

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15
Q

what are the advantages of diuretics to other antihypertensive drugs ?

A

they can be combined
they reduce left ventricular hypertrophy
decrease brain stroke

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16
Q

diuretics are suitable and recommended for who ?

A

isolated systolic hypertension

elderly (FIRST CHOICE)

congestive heart failure with edema

acute heart failure - loop diuretics

renal failure - loop diuretics

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17
Q

what are the adverse side effects for diuretics ?

A

hypokalaemia

LDL increase and lowers HDL transiently

increase uric acid to cause gout

increase blood sugar levels and insulin resistance

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18
Q

chlorothalidone has an adverse reaction in men which is what ?

A

erectile dysfunction

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19
Q

when is diuretics contraindicated ?

A

gout

pregnancy

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20
Q

what are some of the ACE inhibitors ?

A

enalapril

lisinopril

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21
Q

how are ACE hemodynamically active ?

A

lowers peripheral resistance

improve the endothelial function

increases bradykinin

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22
Q

what are the advantages of ACEI

A

decrease LV hypertrophy

fibrinolysis

RENAL PROTECTION - decrease microalbuminurea

METABOLICALY NEUTRAL

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23
Q

for whom are ACEI suitable for ?

A

diabetes mellitus

nephropathy / proteinurea - microalbuminurea

stroke / or after myocardial infraction

congestive heart failure

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24
Q

what are the adverse side effects of ACEi ?

A

cough

allergy

increase risk for gout

hyperkalemia (esp when combined with other RAS )

orthostatic hypotension when combined with thiazides

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25
Q

when are ACEi contraindicated ?

A

2-3rd trim of pregnancy

bilateral renal artery stenosis

angioneurmtic edema

hyperkalemia

gout

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26
Q

ACEI should not be combines with other RAAS inhibitors why ?

A

causes hyperkalemia

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27
Q

ACEI should not be combined with thiazides why ?

A

can cause orthostatic reaction

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28
Q

what are some ARB’s?

A

losartan
valsartan
(Sartans)

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29
Q

what is the hemodynamic mechanism of ARB’s?

A

lower peripheral resistance - no effect on bradykinin

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30
Q

what are the advantages of ARB’s?

A

metabolically inactive

decrease left ventricular hypertrophy

renal protection

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31
Q

to whom is ARB suitable for ?

A

coughing with acei
diabetic nephropathy / proteinurea / microalbuminurea

congestive heart failure

after myocardial infraction

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32
Q

what are the disadvantages of ARB’s?

A

they are expensive

increase risk for gout - EXCEPT LOSARTAN

hyperkalemia (esp when combined with other RAAS)

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33
Q

what are the contraindications of ARB?

A

PREGANCY 1ST AND 2ND TRIMESTER

hyperkalemia

binary stenosis of renal artery

gout

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34
Q

what are the aldosterone antagonists ?

A

spironolactone

eplerenone

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35
Q

what are the renin inhibitors ?

A

aliskiren

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36
Q

what is renin inhibitor suitable for ?

A

congestive heart failure

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37
Q

what are the disadvanatges of renin inhibitors ?

A

expensive

hyperkalemia especially with KIDNEY DISEASE

diarrhea

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38
Q

what the contraindications of aliskiren?

A

pregnancy
chronic kidney disease
kidney disease
DIABETES

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39
Q

what is the hemodynamic mechanism of spironolactone ?

A

decreases cardiovascular remodelling

  • peripheral vascular resistance lowered ???? i dunno
40
Q

what are the advantages of spironolactone ?

A

decreases left ventricular hypertrophy

41
Q

to whom is spironolcatone useful for ?

A

congestive heart failure

after myocardial infraction

42
Q

spironolactone whorls not be used in combination with ACEI and ARB why ?

A

hyperkalemia

43
Q

what are the contraindication of spironolactone

A

pregnancy
hyperkalemia
renal failure

44
Q

how do non DHP hemodynamically active

A

decrease heart contractility

and peripherl vascular resiatsnce

45
Q

what are the advantages of calcium channel blockers ?

A

metabolically inert

decrease left ventricular hypertrophy

decrease risk for stroke

bronchodilator

decrease risk for gout

46
Q

when are calcium channel blockers suitable for patients ?

A

COPD AND ASTHMA

GOUT

DIABETES MELLITUS / METABOLIC SYNDROME

ISOLATED SYSTOLIC HYPERTENSION

INITIAL FOR ELDERLY

peripheral vascular diseae

47
Q

WHICH CALCIUM CHANNEL BLOCKER is given during pregnancy ?

A

nifedipine

48
Q

which calcium channel blocker is good for supra ventricular tachycardia ?

A

non -DHP

49
Q

which calcium channel blocker is suited atrial fibrillation ?

A

non -DHP

50
Q

which calcium channel blocker increases the risk for acute myocardial infraction ?

A

nifedipine

51
Q

which calcium channel blocker increases the risk for bradycardia and conduction disorders ?

A

Non - DHP

52
Q

what is a side effect on blood vessels using non DHP’s?

A

increased risk for bleeding

53
Q

what are the contraindications for DHP?

A

tachyarrythmia’s
congestive heart failure

cardiogenic shock
aortic stenosis
obstructive cardiomyopathy

54
Q

what are the contraindications for NON dhp?

A 
bradycardia 
arrythmia 
sinus syndrome 
congestive heart failure 
low BP

AV block
congestive heart failure

55
Q

what are the non selective BAB’s

A

propranolol

56
Q

what are the CARDIO b1 selective BAB blockers ?

A

metoprolol

bisoprolol

57
Q

what are the vasodilation BAB’s

A

carvedilol

nebivolol

58
Q

how do BAB’a hemodynamically work ?

A

decrease rate of heart contractility

decrease the release of renin

59
Q

what are the advantages of BAB

A

cheap

long term benefit

60
Q

who are suitable for BAB?

A

initial therapy for young adults

coronary heart disease / post acute myocardial infraction

migrane

tachyarrythmia

61
Q

which BAB is preferred in pregnancy esp for IUGR?

A

labetalol - non selective

62
Q

locally used BAB can also help with what ?

A

glaucoma

63
Q

what are the ARD using BAB

A

bronchospasm

decrease HDL and increases TG

bradycardia and conduction disorder

INCREASE INSULIN RESISTANCE

sexual disorders

hypoglycemia and mask hypoglycemic signs

64
Q

what is a ADR using non selective BAB

A

peripheral vascular spasm

65
Q

compared to others why are BAB’s relatively bad to

A

decrease let ventricular hypertrophy slower rate than the other drugs

66
Q

what are the contraindications to BAB

A

asthma / COPD (use beta selective)

AV block and bradyarrythmia

peripheral vascular diseases

athletes

decompnesated heart failure

cardiogenic shock

diabetes

prinzenetal angina

67
Q

what are the alpha adrenergic blockers ?

A

praZOSIN

doxaZOSIN

68
Q

what are the advantages of alpha adrenergic blockers

A

increase hdl

improve insulin sensitivity

decrease lv hypertrophy

improve fibrinolysis

69
Q

who are alpha adrenergic blocker suitable for ?

A

diabetes
prostate hypertrophy
lipid disorders

70
Q

what re the disadvantages of alpha adrenergic blockers ?

A

orthostatic reactions

sexual problems

headache

risk of CONGESTIVE HEART FAILURE S DOUBLE

71
Q

contraindications of alpha blockers are ?

A

congestive heart failure

72
Q

what are the targets for blood pressure ?

A

systolic BP less than 140mmhg

elderly less than 150 mmhg

chronic kidney disease less than 130mmhg

diastolic less than 90 mmhg
diastolic in DM < 85mmhg

73
Q

in in grade 1 AH risk patients what kind of therapy do we give ?

A

low dose mono therapy

74
Q

in higher risk AH2 / 3 patient what kind of therapy do we give ?

A

initial low dose of ditherapy of two agents

75
Q

what if the therapy does not work ?

A

make it to full dose
switch medicine
two or three drug combination
two or three drug combination in full dose

76
Q

which two drug combinations are contraindicated ?

A

ACEi and ARB

77
Q

which two drug combinations are preferred ?

A 
thiazides + ACEI
thiazides + CCB
thiazides +ARB
ARB+ CCB
CCB+ACEI
78
Q

what are the drugs that should be stopped capable of rising BP?

A 
NSAID 
GLOCOCORTICOIDS 
COMBINEd HORMNOAL CONTRACEPTIVES 
COCAINE 
AMPHETAMINE 
CYCLOSPORIN
79
Q

WHICH ANTIHYPERTENSIVE DRUGS ARE PREFFERED FOR CEREBROVASCULAR DISEAS OR COGNITIVE DISORDERS

A

CCB / thiazides

in combo with RAAS blockers

80
Q

in elderly and DM how many combo of drug are necessary ?

A

ditherapy

81
Q

in coronary heart disease/ hf what is considered first line therapy ?

A

BABS and RAAS - reduce the rate of reinfraction

CCB - contraindicated

82
Q

how many drug combo necessary in CKD ?

A

tritherapy

83
Q

what is gestational hypertension ?

A

develops 20th gestational week without proteinuria

84
Q

what is pre-eclampsia ?

A

develops 20th gestational week with proteinuria

85
Q

drug therapy in pregnancy needed when

A

gestation and chronic = 150/100

pre-eclampsia = 170/110

86
Q

what are the preferred drugs in pregnancy ?

A

labetelol , nifedipine , methydopa

second choice - BABS :( possible intrauterine growth restriction and retardation

hydralazine - iv

asa given after 12th gestational week at high risk for pre- eclampsia

magnesium sulfate iv - prevent eclampsia

87
Q

at wha bp does it become hypertensive crisis ?

A

180/120 mmhg

88
Q

in hypertensive crisis therapy should be targeted at what bp

A

160/100

within 3-6 hours

89
Q

hypertensive criss with organ damage goes through what therapy ?

A

parenteral therapy

target - 25 percent less of bp within first hours
then bp gradually and cautiously reduced to 160/100 and normalise in the next 24/48hr

90
Q

rapid and abrupt lowering of bp can lead to what ?

A

brain , coronary and renal ischema

91
Q

rapid lowering of bp should be avoided in all cases except ?

A

acute pulmonary edema and aortic dissection

92
Q

in hypertensive crises what are the drug preferred

A 
labetelol
sodium nitroprusside
nicardipine
nitroglycerine
enalapril
93
Q

in hypertensive patients with diabetes what is the hb1ac target ?

A

below 7 percent with anti diabetic treatment

statins are also recommnended for moderate to high cv risk

94
Q

patients with reduced renal function and HIGH CV risk (not mild to moderate) should be recommended what ?

A

antiplatelet - aspirin

95
Q

whata re the centrally acting sympatholytics

A

clonidine
methyl dopa
rilmenidine

pharmacology (7 decks)

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